Firstly, the most important thing to note is that everyone with a bladder problem can be helped and many can be cured.

Urinary incontinence is the  release of urine unwillingly. It can affect both men and women and there are a number of reasons for this and there are also a number of ways it can be treated or managed.

The Continence and Urodynamics Unit at the Bristol Urological Institute (BUI), is a centre of excellence with a national and international reputation in the assessment and treatment of  urinary incontinence. The unit offers secondary and tertiary regional, national and international services for urinary incontinence. Urinary incontinence comes under the umbrella of female urology, neurourology and urodynamics, often termed functional urology.

Clinicians, specialists nurses, continence advisors and physiotherapists come together to run a dedicated incontinence clinic at the BUI.

The service is led by a team of three clinical experts, Prof Paul Abrams, Prof Marcus Drake and Mr Hashim Hashim, who have gained an international reputation for their dedication into developing new diagnostic tools, treatments and devices to help those suffering from what was seen as, until recently, a taboo and unmanageable disease.

Types of Urinary Incontinence

Stress incontinence
This type of incontinence actually does not have anything to do with emotional stress but is related to pressure to the bladder such as being overweight, pregnancy, sneezing, lifting heavy objects, exercise and some medical conditions. Leakage is due to a weakness of the pelvic floor that supports the bladder and the urethra. It is often termed ‘ effort’ incontinence.

Treatments for stress incontinence in women
Non-surgical treatments include:

• Restricting fluid intake
• Stopping smoking
• Reducing weight
• Pelvic floor exercises
• Medications such as Duloxetine

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment.aspx

For 1 in every 3 women with symptoms of stress incontinence these non-operative treatments can make symptoms much better or cure them completely.

Surgical Treatments for Stress Incontinence at BUI
Surgical treatments include:

• Injection/Bulking agent treatment
• Sling procedures (Natural and Synthetic)
• Colposuspension
• Artificial Urinary Sphincter

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Operations for stress incontinence depend on supporting the urethra. There are several  operations to cure this type of leakage, and the BUI is one of the few centres in the United Kingdom that can offer all these treatments. According to the National Institute of Clinical and Health Excellence (NICE), women with stress incontinence should be offered all forms of treatment and not restricted to one type. NICE also recommend that women are discussed in a multidisciplinary team meeting. The surgeons at the BUI are also experts in dealing with tape complications and are the regional centre for such treatments.

Stress Incontinence in Men
The most common reason for men having stress incontinence is due to treatment for prostate cancer. Surgery and radiotherapy can weaken pelvic floor muscles and the urethral sphincter (a ring of muscle that keeps the urethra closed)

Non-surgical treatments include:

• Pelvic floor muscle training (PGMT)
• Bladder retraining
• Medicines

Surgical treatments include:

• Artificial sphincter
• Male Sling
• Urethral bulking
• Penile clamp

For more information about these treatments visit www.nhs.uk/Conditions/Incontinence-urinary/Pages/Treatment-surgical.aspx

Urgency incontinence and overactive bladder (OAB) syndrome
This type of incontinence is characterized by a strong urge to urinate with no ability to stop it and often leads to leaking before reaching the toilet in time. It can affect about 12% pf the population with no known cause or it can be caused by as a result of an injury to nerves or muscles which help control urinary flow but it can also be caused by some medical conditions.

The doctor/nurse will ask you questions about the problem and your general health. He/she may do a physical external examination, perform an internal examination and a urine test will be done to check for infection. You will be asked to complete a 3-day frequency/volume chart to record the time of voiding and volumes of urine passed. A flow test may also be performed. This is a test which involves passing urine into a special machine to measure the strength of flow and to check whether the bladder has emptied completely.

If the symptoms fail to respond to conservative and medical treatment a more invasive investigative test may be performed called urodynamics. This is a special test to measure pressures inside the bladder.

Treatments:

• Change of drinking habits
• Bladder training
• Medication
• Surgery

Surgery for Overactive Bladder
The surgeons at the BUI are the only centre in the South West of England that can offer all forms of treatment for refractory overactive bladder syndrome including Botox injection in the bladder, Sacral nerve stimulation, and major surgery.

Pelvic Organ Prolapse
Mr Hashim is one of a few urologists in the United Kingdom who is fellowship trained in pelvic organ prolapse repair in women and also works closely with urogynaecologists and colorectal surgeons at Southmead Hospital to offer a first-class service for women with prolapse.

Pelvic organ prolapse is the bulging of one or more of the pelvic organs (uterus, vagina and bowel) into the vagina. Pelvic organ prolapse can affect the front, top or back of the vagina.

Symptoms are:

• the sensation (feeling) of something coming down or protruding of the vagina
• discomfort during sex
• problems passing urine 

Some women with a pelvic organ prolapse don't have any symptoms and it’s only discovered during an internal examination such as a cervical screen.

Pelvic organ prolapse isn't life-threatening, but it can affect your quality of life.

The main types of prolapse are:

• anterior prolapse (cystocele) – where the bladder bulges into the front wall of the vagina
• prolapse of the uterus and cervix or top of the vagina – which can be the result of previous treatment to remove the womb
• posterior wall prolapse (rectocoele or enterocoele) – when the bowel bulges forward into the back wall of the vagina

It's possible to have more than one of these types of prolapse at the same time.

Genito-urinary Fistula
A fistula is an abnormal communication between the bladder and the vagina or the urethra and the vagina. This causes women to leak continuously. The BUI surgeons are trained in vaginal and abdominal vesico-vaginal and urethro-vaginal fistula repairs and offer a regional and tertiary service for such repairs.

Andrology & Male Urethral Reconstruction

Andrology is a subsection of Urology which deals with problems affecting the male reproductive system. These conditions may present as emergencies or through our outpatient clinics.

We currently have an experienced team of 4 consultants and a senior specialist Andrology nurse with over 15 years of experience.

We provide care for the whole or Bristol and act as a tertiary referral centre for South-West England.

We also have a long tradition of research following on from the Dr Gingell who did the original UK research on Viagra.

In addition, we have had 4 MDs in collaboration with the cardiac institute researching the various factors causing erectile dysfunction.

Andrology Team

Prof Raj Persad
Mr Salah Al-buhessi
Mr David Dickerson
Mr Rupert Beck
Miss Wendy Hurn

We manage the following conditions:

Priapism
This is an abnormal prolonged erection which requires emergency treatment.

Penile fracture
This is due to a tear in the lining (tunica albuginea) of the penile erectile apparatus. This requires emergency surgical treatment.

Torsion
This is a twist in the tube from which the testis is suspended (spermatic cord). This results in the blood supply to the testis being cut off. It requires emergency surgery to untwist the spermatic cord rapidly or it results in loss of the testis.

Genito-urinary trauma

Erectile dysfunction
This is an inability to either develop or sustain an erection sufficient for sexual intercourse. It is common and often very distressing. It may be due to medical conditions such as diabetes or following surgery for cancer.

Ejaculatory disorders including premature ejaculation
This is an abnormality of the expulsion of semen. It is a very distressing condition and is probably the most common sexual dysfunction in men.

Penile curvature
This condition is either present lifelong (congenital penile curvature) or may develop over time (Peyronie’s disease). Peyronie’s disease is due to scarring of the tunica albuginea thereby creating a plaque.

Urethral stricture disease
This is a scarring condition of the male waterpipe (urethra). This results in difficulty passing urine and emptying the bladder.

We also offer the following treatments:

• Penile prosthesis
  This may be inserted electively or as an emergency. The indications are for end stage erectile dysfunction, prolonged priapism or severe penile curvature associated with erectile dysfunction.
• Surgery for penile curvature
  This is either a Nesbitt’s plication or a Lue procedure. The aim of both procedures is to create a straight and functional penis. Nesbitt’s involves the excision of part of the penile tissue. A Lue involves incision of the Peyronie’s plaque and the insertion of a graft.
• Urethroplasty
  This is the excision and repair of the urethra which has been affected by stricture disease. This may involves the insertion of a graft.
• Penectomy and penile reconstruction
  This is the excision of some or all of the penis due to cancer. Where only part of the penis has been removed, we also offer surgery to re-fashion the penis so it looks as close to normal as possible. This is penile reconstruction. Penile reconstruction may also be offered where the penis or foreskin has been affected by non-cancerous conditions.

Men with non-emergency conditions may be referred to us via their GP through NHS eReferrals to our andrology clinics either at Southmead or at South Bristol.

Useful Links

Sexual Advice Association: www.sda.uk.net
NHS UK: www.nhs.uk/livewell/goodsex

The specialist stone unit at the BUI, Southmead Hospital, Bristol,  provides services for Bristol, the surrounding region, and as a tertiary referral centre for South West England.

After clinical review, our expert stone surgeons suggest management plans that are individually tailored to you, the patient. Management decisions are typically based upon stone factors (type, size and location), kidney factors (number, function, previous surgery) and patient factors (other illnesses or factors that may make surgical intervention higher risk).

The stone services offered through the specialist stone unit includes:

Onsite extra-corporeal shockwave lithotripsy (ESWL)

This treatment uses machine generated shock waves to break up urinary stones. The treatment sessions are carried out as daycase procedures and last for approximately 30 minutes. You should be sent home within 2-4 hours. The stone unit has an onsite lithotripter and a dedicated lithotripsy team who meet weekly to plan stone treatments. We offer an emergency shock wave lithotripsy service and are involved in national trials in stone treatment.

Uretero-renoscopy and laser lithotripsy

This treatment is carried out under a general anaesthetic and involves a thin camera is passed through the urethra, bladder and into the ureter and/or kidney. A tiny laser is then passed through the camera and is used to break up stones into smaller pieces. These procedures are typically carried out as daycase. You may have a plastic tube (stent) left inside to help protect the drainage of the kidney after this procedure.

Percutaneous nephrolithotomy

This treatment is carried out under a general anaesthetic and involves a small incision in the skin near the kidney affected by kidney stones. A needle is then inserted into the kidney by an interventional radiologist under ultrasound guidance. The needle entry is then stretched enough to allow a special camera instrument to pass into the kidney and retrieve the stone fragments. This type of treatment is typically reserved for larger kidney stones (greater than 1.5-2 cm) or stones which are difficult to access with a flexible uretero-renoscope. Following this procedure you would typically stay in hospital for 1 to 5 days.

Laparoscopic and open renal stone surgery

This treatment is rarely used and is always carried out under general anaesthetic. Laparoscopic surgery involves multiple keyhole incisions in the abdomen. An open operation involves a large incision (10-15 cm) over the flank, to expose over the site of the kidney or ureter. This treatment maybe offered, for exmaple, if other stone treatment methods have not been successful or there is little or no remaining kidney function in a kidney with stone disease.

Metabolic stone service

We work alongside our colleagues in the renal (kidney), biochemistry and microbiology departments in order to identify reasons why patients form recurrent kidney stones. The aim of metabolic tests is to prevent stone recurrence.  

This page has information about the Urology One Stop Clinic. 

What is the clinic for? 

The Urology One Stop Clinic aims to help patients have consultations and tests all done in one visit. This is more efficient for you and us. 
You may see different members of the multidisciplinary team (MDT) including doctors, specialist nurses and radiographers. 

How soon will I be seen? 

You must be referred by your GP. If you are referred because your GP suspects you might have cancer, we try to see you within 2-3 weeks of your referral. This is often called a “fast-track referral.” For other referrals we aim to see you within 6-8 weeks. 

Before your visit 

• You may be sent some leaflets or forms to complete in the post or by text. Please read them carefully.
• Your letter may ask you to arrange or some blood or urine tests at your GP. It is important you do this so we have the results ready for your appointment.
• If you are going to have a CT scan, you may be advised to drink water or not eat for a few hours before this. Please check your letter for instructions.
• Please bring a list of any medicines you take including ones you buy yourself such as herbal remedies.
• It can be useful to bring someone with you to appointments. 

During your visit

You will usually see a doctor or nurse first, and they may then send you for some tests or scans. Some will be on different days.  These may include:

• Urine tests.
• Blood tests.
• Flow rate tests.
• Questionnaires about your symptoms.
• Flexible cystoscopy.
• Ultrasound.
• X-rays.
• CT scan.
• MRI scan.

If you need surgery: 

• You may be asked to go to one of our pre-assessment clinics to check you are fit for the procedure. This might include tests like an ECG (heart trace), blood tests, and X-rays.  

Questions to ask

When you come to your Urology One Stop appointment, you may have a lot of questions. It is normal to find it difficult to remember things at the time of and after your appointment so here are some tips to help you.  

Before your appointment

During your appointment

After your appointment - don't forget the following

Tests, such as blood tests or scans

What next?

© North Bristol NHS Trust. This edition published June 2025. Review due June 2028. NBT003478.

For elective surgery, patients are asked to report to Theatre reception at Gate 21, Level 3 in the Brunel building, Southmead Hospital.

Patients who require a hospital stay after their surgery (inpatient) will be transferred from to Ward 34b which is a dedicated urology ward.

GMC number: 6041454

Year & location of first qualification: 1994, Gulburga University, Karnataka, India

Specialty: Infectious Diseases and Microbiology

Clinical interests: Infection, Antimicrobial therapy, pharmacokinetics/pharmacodynamics of antimicrobial therapy, sepsis.

Secretary: Josephine Poad

Telephone: 0117 414 6273

Member of Royal College of Physicians, London
Member of Royal College of Pathologists, London
Member of British Infection Association
Member of British Society of Antimicrobial Chemotherapy
Member of European Society of Clinical Microbiology and Infectious Diseases

What is Urology

Urology is the field of medicine that focuses on the urinary tract and the male genital organs.

 

The urinary tract consists of the:

• kidneys
• bladder
• ureters
• urethra.

The organs covered by urology include the:

• kidneys
• ureters
• urinary bladder
• urethra
• male reproductive organs (testes, epididymis, vas deferens, seminal vesicles, prostate and penis)

Urology is a surgical speciality and can trace its origin to medieval lithologists, who specialized in surgical removal of bladder stones. Today, urology combines management of medical (i.e. non-surgical) problems such as urinary infections and surgical problems such as the correction of congenital abnormalities and the surgical management of cancers.

Only 15-20% of patients who are referred to Bristol Urological Institute by GPs require surgery. So, if you are referred to us this does not mean you will necessarily be advised to have an operation.

Bristol Urological Institute accepts general referrals for urological problems including patients suffering with stones, incontinence, suspected cancer, erectile dysfunction and catheter problems.

All two week wait referrals should be made via NHS e-Referrals.

For inter-provider referrals for cancer care email: cancerservices@nhs.net

Patients are normally referred mainly from secondary care, particularly gynaecologists and urologists.

The majority of referrals are from Bristol and the surrounding area but we also receive referrals from the rest of the South West and beyond.

Urinary Retention & Catheter Related Problems

Visit this page to access a guide on the management of patients with urinary retention or other catheter related problems.

GMC Number: 4621409

Year of first qualification: 1999, University of Nottingham

Speciality: Acute Medicine

Clinical interests: Acute kidney injury

Secretary: Lisa Williams

Telephone: 0117 414 1141

Will you help us?

Please tell us about your experiences using our Maternity Services. We want to provide you with the best possible care and support during your pregnancy and after the birth of your child. It’s important to us that we hear from as many people as possible about their experience using our services so that we understand what is working well and what we can improve. Take a moment to share your feedback to help future mums, partners, and families using Maternity Services at North Bristol NHS Trust. 

What is the Friends and Family Test?

A way for patients to give us feedback by answering two simple questions.

The NHS Friends and Family Test (FFT) is a quick and anonymous way for people to provide feedback on the care or treatment they received from NHS services. 

The ratings and comments patients share with us help us to identify areas for improvement and to give staff the opportunity to hear about the difference they have made through the care they’ve received.

The results, in the form of the percentage of patients with a good experience, are published transparently on the NHS website. 

You can find out more about how it works by watching the following FFT animations on YouTube:

• NHS Friends and Family Test
• NHS Friends and Family Test (British Sign Language translation)

What questions will you ask me?

You will be invited to complete the FFT at several points during your care. In Maternity Services this will include:

• Antenatal care – following your 36-week antenatal appointment
• Birth and care on the postnatal ward – you will be surveyed at or shortly after discharge from the ward/birth centre/following a home birth.
• Postnatal community care – you will be surveyed at discharge from the care of the community midwifery team to the care of the health visitor/GP (usually at 10 days postnatal)

You may be asked while you're still on the premises by a staff member or one of our Feedback Volunteers, or you may be contacted once you have returned home. We may ask you to give your feedback by email, feedback cards, text message, or using our website.

If you do not want us to contact you to ask for your feedback you can tell us by contacting PALS on 0117 414 4569 or by emailing PALS@nbt.nhs.uk. 

North Bristol NHS Trust work with Healthcare Communications to collect FFT feedback. Our lawful basis for processing your data can be found in the Trust’s Privacy Policy. Please refer specifically to Article 6 (e) & (f) of the General Data Protection Regulations which is relevant to this project.

You may not be asked every time you visit one of our hospitals to give feedback, but you should be able to give feedback if you want to. You can: 

• fill out the online form that is linked on this page
• scan a QR code found on posters across our hospitals that will take you to the survey
• fill out a feedback card in waiting areas and wards

If you cannot find a feedback card and want to fill one out, please ask a member of staff. You can always use links to the relevant surveys below:

Antenatal feedback

Birth feedback 

Postnatal Ward feedback 

Postnatal Community feedback 

How can I find out what you have done with my feedback?

All our departments display a poster with the positive and negative scores for their department. These posters will also share some things people have told us about their experience and what we have done to improve that. You can also find the scores on the NHS England website.

Do I have to respond to the question?

Your answer is voluntary. Your answer will not be traced back to you, and your details will not be passed on to anyone.

But if you do answer, your feedback will provide valuable information for the service to celebrate positive feedback and identify opportunities to make improvements.

Is it for my friends and family members to fill out?

It is for you or your friends, family members and carers to respond to.

Why is it called the Friends and Family Test?

When the Friends and Family Test was launched in 2013, it asked people to think about whether they would recommend the service to their friends or family members. 

In April 2020 changes were made to the FFT to make it easier to respond to and for staff to make better use of the feedback. As a result, it no longer asks this question about friends and family members, but it is still called the Friends and Family Test.

Accessible to all

We want to make sure that everyone is enabled to give feedback about their care. The web version of our survey has a button built in that adds text-to-speech, reading and translation support. However, if you need assistance due to a disability or mental health condition or you need a paper copy of the survey, please contact us by telephoning 0117 414 4569 or emailing PALS@nbt.nhs.uk. 

A friend or family member is welcome to answer the question on your behalf, if this is appropriate.

If you feel that you should have been given the opportunity to respond, but did not receive the question, you can give feedback on this page by selecting the relevant survey below:

Antenatal feedback

Birth feedback 

Postnatal Ward feedback 

Postnatal Community feedback